区域神经阻滞麻醉在股骨粗隆间骨折手术中的应用效果

doi:10.3969/j.issn.2095-9400.2021.06.012

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摘要目的：探讨区域神经阻滞麻醉在股骨粗隆间骨折手术患者中的应用效果。方法：回顾性分析2020年3月至2020年12月温州市中心医院行手术治疗的75例股骨粗隆间骨折患者的临床资料。根据麻醉方式不同分为区域神经阻滞组（n=34）和椎管内麻醉组（对照组，n=41）。其中区域神经阻滞组：采用腰丛+股神经或股外侧皮神经阻滞麻醉；对照组：行椎管内麻醉。对比分析两组术中及术后2、4、8 h疼痛视觉模拟评分（VAS），术前、术后白蛋白水平，术中、术后动脉压变化，并发症发生率（低血压、谵妄、尿潴留），生活自理能力（ADL）评分，住院时间和住院费用。结果：与对照组比，区域神经阻滞组术中及术后2 h、4 h、8 h VAS评分均降低（P＜0.05）；术后白蛋白下降幅度小[（4.47±2.36）g/L vs. （6.52±2.34）g/L，P＜0.05]。麻醉前两组动脉压差异无统计学意义[（101.6±8.1）mmHg vs. （104.2±9.1）mmHg]，但切皮时、术中20 min和术中40 min区域神经阻滞组动脉压较对照组下降幅度小[（103.2±9.1）mmHg vs. （93.8±8.2）mmHg，（100.9±8.3）mmHg vs. （91.9±7.1）mmHg，（97.9±7.2）mmHg vs. （91.8±5.8）mmHg，P＜0.05]。术后并发症发生率：区域神经阻滞组低血压发生率低（5.88% vs. 26.83%，P＜0.05），但术后谵妄发生率（5.88% vs. 12.20%）和尿潴留发生率（8.82% vs. 19.51%）两组差异无统计学意义（P＞0.05）。区域神经阻滞组较对照组ADL评分升高[（26.9±4.4）分 vs. （21.3±2.5）分]，但住院时间[（11.1±3.7）d vs. （14.8±9.4）d，P＜0.05]和住院费用[（27 142.5±5 676.0）元 vs. （31 828.7±9 065.4）元]均减少（P＜0.05）。结论：区域神经阻滞麻醉在股骨粗隆间骨折手术中具有良好镇痛效果，可减轻负氮平衡，缩短住院时间，减少住院费用，促进患者自理能力恢复，加速患者康复。

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	郑均炬
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关键词 ：区域神经阻滞, 股骨粗隆间骨折, 局部麻醉, 谵妄

Abstract：Objective: To investigate the effect of regional nerve block anesthesia in the operation of intertrochanteric fracture. Methods: Clinical data of 75 patients with intertrochanteric fracture who underwent operation from Mar. 2020 to Dec. 2020 in Wenzhou Central Hospital were retrospective analyzed. They were divided into two groups:the regional nerve block anesthesia group (n=34) that underwent combined block anesthesia of lumbar plexus nerve, femoral nerve or lateral femoral cutaneous nerve, and the control group (n=41) that underwent spinal anesthesia. A comparison was made between the two groups in intraoperative and 2, 4, 8 h
postoperative VAS scores, albumin level, the incidence of postoperative complications (hypotension, delirium, uroschesis), ADL scores, hospitalization time and the cost of hospitalization. Results: Intraoperative and 2, 4, 8 h postoperative VAS scores and the decrease of albumin [(4.47±2.36)g/L vs. (6.52±2.34)g/L] in regional nerve block anesthesia group were significantly lower than those in the control group (P<0.05). The arterial pressure of the two groups has no significance before anesthesia [(101.6±8.1)mmHg vs. (104.2±9.1)mmHg], but during the operaiton of skin incision, 20 min and 40 min, it decreased slightly [(103.2±9.1)mmHg vs. (93.8±8.2)mmHg, (100.9±8.3)mmHg vs. (91.9±7.1)mmHg, (97.9±7.2)mmHg vs. (91.8±5.8)mmHg, P<0.05]. Compared with control group, lower incidence of postoperative hypotension (5.88% vs. 26.83%) was found, but there was no significant difference in the incidence of postoperative delirium (5.88% vs. 12.20%) and postoperative uroschesis (8.82% vs. 19.51%) between the two groups. ADL scores were higher in regional nerve block anesthesia group than those in control group [(26.9±4.4) vs. (21.3±2.5), P<0.05]. Hospitalization time [(11.1±3.7)d vs. (14.8±9.4)d] and the cost of hospitalization [(27 142.5±5 676.0)yuan vs. (31 828.7±9 065.4)yuan] were better in regional nerve block anesthesia group (P<0.05). Conclusion: Regional nerve block anesthesia in the operation of intertrochanteric fracture has better analgesic effect in that it reduces the negative nitrogen balance, hospitalization time and the cost of hospitalization, and also accelerates postoperative recovery.

Key words： regional nerve block anesthesia intertrochanteric fracture local anesthesia delirium

收稿日期: 2021-01-05

作者简介: 郑均炬，主治医师，Email：zhengjunju@sina.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.06.012 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I6/491

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